Mentor Questionnaire - Match Survey
Thank you for your interest in being a mentor with Shine! Your survey responses will be input into our greater database where you will be matched with a mentee with similar attributes, and your survey responses will be confirmed with a “Thank you” email.
As a mentor, you provide support to women struggling with fertility issues. Please make sure you are comfortable with reaching out to your mentee and making time to create a meaningful relationship with her.
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State, Zip Code *
Your answer
Phone Number (including area code) *
Your answer
Email Address *
Your answer
At what age did you start trying to get pregnant?
Your answer
At what age did you become a mother?
Your answer
Were you diagnosed with a specific type of infertility? If yes, what? (ex. PCOS)
Your answer
What doctor(s) and clinic(s) did you use?
Your answer
How long were you in fertility treatments?
Your answer
How many IUI procedures?
Your answer
How many IVF procedures?
Your answer
Any other procedures you had to undergo?
Your answer
What method or path ended up getting you pregnant/or becoming a mother?
Your answer
Who did you go to for support through this process?
Your answer
What other support did you seek out (check all that apply)?
Did you have family or friends that had experienced similar issues?
Your answer
How did you pay for your fertility treatments?
As a mentor, what types of communication with your mentee are you comfortable with? (check all that apply)
Please include any other information that will help us best place you with a mentee.
Your answer
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